头孢哌酮舒巴坦联合替加环素治疗肺部感染泛耐药鲍曼不动杆菌患者的疗效分析

The clinical effect of cefoperazone sulbactam associated with tigecycline on pulmonary infection caused by pan drug-resistant Acinetobacter baumannii

目的：探讨头孢哌酮舒巴坦联合替加环素对综合重症监护病房（ICU）内肺部感染泛耐药鲍曼不动杆菌患者的疗效。方法回顾性分析88例2011年1月至2013年6月广东省佛山市中医院ICU收治的肺部感染泛耐药鲍曼不动杆菌脓毒症患者的治疗情况，其中82例使用了抗菌药物，其余6例因家属不同意或者放弃治疗而未使用抗菌药物。在使用抗菌药物的患者中，27例选用头孢哌酮舒巴坦（为A组）；30例选用头孢哌酮舒巴坦联合阿米卡星（为B组）；25例选用头孢哌酮舒巴坦联合替加环素（为C组），抗菌药物使用7～15 d。观察治疗前后白细胞计数（WBC）、C-反应蛋白（CRP）和降钙素原（PCT）变化，记录各组患者细菌学有效率、脱机成功率、28 d病死率及临床疗效。结果 A、B、C组治疗前WBC、CRP、PCT比较差异均无统计学意义（均P＞0.05），治疗后各指标均较治疗前呈降低趋势（均P＜0.05），且以C组PCT降低更显著〔WBC（×109/L）：17.01±5.35比20.40±6.54、18.28±6.41；CRP（mg/L）：64.6±8.4比68.3±12.7、70.0±13.4；PCT（μg/L）：20.84±7.26比36.14±10.12、52.66±13.47，P＜0.05〕。C组细菌学有效率、脱机成功率均较A组和B组明显升高（细菌学有效率：76.00%比44.44%、46.67%，χ2＝9.750，P＝0.006；脱机成功率：72.00%比40.74%、43.33%，χ2＝12.083，P＝0.009），28 d病死率较A组、B组明显降低（24.00%比48.15%、36.67%，χ2＝11.510， P＝0.030）。C组临床总有效率较A组和B组明显升高（76.00%比44.44%、46.67%，均P＜0.05）。结论头孢哌酮舒巴坦联合替加环素可以降低ICU内肺部感染泛耐药鲍曼不动杆菌患者的炎症反应，提高脱机成功率和生存率，具有较好的临床疗效。

Objective To approach the clinical effect of cefoperazone sulbactam associated with tigecycline for treatment of patients with severe pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in intensive care unit（ICU）. Methods Retrospectively,the treatments of 88 patients with sepsis and pulmonary infection caused by pan drug-resistant Acinetobacter baumannii admitted in ICU from January,2011 to June,2013 were analyzed,among them antibiotics were used for 82 patients,and the rest 6 patients did not use antibiotics because of family refusal or abandonment of therapy. The patients having used antibiotics were divided into three groups：A group（27 patients）received cefoperazone sulbactam,B group（30 patients）received cefoperazone sulbactam associated with amikacin,and C group（25 patients）received cefoperazone sulbactam associated with tigecycline, antimicrobial treatment being for 7-15 days. The venous blood was collected to determine the changes in white blood cell count（WBC）,C-reactive protein（CRP）and procalcitonin（PCT）before and after therapy. The rate of bacteriological efficiency,successful weaning of mechanical instrument,28-day mortality rate and clinical efficacy were observed after therapy in three groups. Results Before therapy,the comparisons of levels of WBC,CRP and PCT among three groups were of no statistically significant difference（all P〉0.05）,and they were decreased obviously after therapy in three groups among which they were decreased most significantly in C group〔WBC（×109/L）：17.01±5.35 vs. 20.40±6.54,18.28±6.41;CRP（mg/L）：64.6±8.4 vs. 68.3±12.7,70.0±13.4;PCT（μg/L）：20.84±7.26 vs. 36.14±10.12,52.66±13.47,P〈0.05〕. The rates of bacteriological efficiency and successful weaning in C group were increased more significantly than those in either A or B groups after therapy（bacteriological efficiency：76.00%vs. 44.44%,46.67%,χ2=9.750,P=0.006;rate of successful weaning：72.00%vs. 40.74%, 43.33%,χ2=12.083,P=0.009）,and 28-day mortality rate in C group was much lower than those in A and B groups （24.00% vs. 48.15%,36.67%,χ2=11.510,P=0.030）. The total clinical efficiency in C group was much higher than those in A and B groups（76.00%vs. 44.44%,46.67%,both P〈0.05）. Conclusion Cefoperazone sulbactam associated with tigecycline has significant clinical therapeutic effect in patients with pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in ICU,as it can decrease inflammatory reaction,increase the rates of successful weaning and survival.